2005 Management and outcome of empyema thoracis: experience in a regional hospital
Dr. Wai-lam Law, Department of Medicine, Queen Elizabeth Hospital
Introduction and methods
This is a retrospective study to evaluate the clinical features, microbiological patterns, radiological features, management and outcome of patients with empyema thoracis in Queen Elizabeth Hospital.
Results
53 eligible patients with empyema thoracis were included from 1st January 1999 to 31st December 2003. The most common presenting symptoms were fever (69.8%) and chest pain (64.2%). A significant proportion of our patients (41.5%) had known risk factors for developing empyema. The most common co-morbidities were diabetes mellitus (23.3%), previous cerebrovascular accident (11.6%) and carcinoma of lung (11.6%). Streptococcus milleri was the most common etiological agent. Loculations and pleural thickening were found in 58.5% and 49.1% of cases respectively. Image-guided catheter drainage was performed in 26 (49.1%) patients and the corresponding success rate was 57.7%, which was higher than that of conventional chest drainage (37%). A total of twenty patients (37.7%) were successfully treated with non-surgical method (antibiotics plus medical drainage) while 29 (54.7%) patients need surgical decortications. The mean hospital stay was 25.7 +/- 11.7 days. Prolonged hospitalization (greater than or equal to 30 days) occurred in 20 (37.7%) patients. Thirteen patients (24.5%) had adverse outcomes including intensive care utilization and death, with overall in-hospital mortality was 7.5% (4 cases died). Multivariate analysis showed that positive pleural fluid Gram’s staining for bacteria and presence of loculations on imaging were two independent predicting factors for non-surgical treatment failure in empyema thoracis.
Conclusion
Early aggressive surgical intervention should be considered in patients with loculated empyema or empyema with positive pleural fluid Gram’s staining for bacteria.
